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Impact of strut–vessel distance and underlying plaque type on the resolution of acute strut malapposition: serial optimal coherence tomography analysis after everolimus-eluting stent implantation

  • Takumi Inoue
  • Toshiro Shinke
  • Hiromasa Otake
  • Masayuki Nakagawa
  • Hirotoshi Hariki
  • Tsuyoshi Osue
  • Masamichi Iwasaki
  • Yu Taniguchi
  • Ryo Nishio
  • Noritoshi Hiranuma
  • Akihide Konishi
  • Hiroto Kinutani
  • Masaru Kuroda
  • Ken-ichi Hirata
Original paper

Abstract

The consequences of acute strut malapposition in everolimus-eluting stents (EES) are unknown. This study investigated the impact of strut–vessel (S–V) distance and plaque type underneath acute strut malapposition on the mid-term vessel response in EES. Twenty-nine patients (35 EES) underwent optical coherence tomography (OCT) immediately after percutaneous coronary intervention and at 8-month follow-up. S–V distance and plaque type (lipid, calcified, or fibrous) underneath acute strut malapposition were evaluated. Follow-up OCT classified acute strut malapposition as persistent or resolved. The S–V cutoff value for predicting resolved strut malapposition and the incidence of intra-stent thrombi were determined. Among 569 cases of acute strut malapposition, involving 29,168 struts, 139 (24.4 %) were persistent. Mean S–V distance was significantly longer in persistent than in resolved strut malapposition (600 ± 294 vs. 231 ± 95 μm; P < 0.0001). S–V distance ≤380 μm was the best cutoff value for predicting resolved strut malapposition (sensitivity 93.5 %, specificity 69.8 %, area under curve 0.878). Acute strut malapposition with S–V distance ≤380 μm remained persistent more frequently over lipid/calcified than over fibrous plaques (lipid: 13.4 %, calcified: 18.2 %, fibrous: 4.2 %; lipid vs. fibrous, P = 0.001; calcified vs. fibrous, P = 0.02). Intra-stent thrombi were more frequent in stents with ≥1 persistent strut malapposition than in those without [4/11 stents (36.3 %) vs. 0/24 (0 %); P = 0.006]. Lipid and calcified plaque, together with S–V distance, affect the resolution of acute strut malapposition in EES. Persistent strut malapposition is associated with the presence of thrombi at follow-up, which could be the substrate for late stent thrombosis.

Keywords

Optical coherence tomography Everolimus-eluting stents Strut malapposition Lipid plaque 

Notes

Conflict of interest

No conflicts of interest.

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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Takumi Inoue
    • 1
  • Toshiro Shinke
    • 1
  • Hiromasa Otake
    • 1
  • Masayuki Nakagawa
    • 1
  • Hirotoshi Hariki
    • 1
  • Tsuyoshi Osue
    • 1
  • Masamichi Iwasaki
    • 1
  • Yu Taniguchi
    • 1
  • Ryo Nishio
    • 1
  • Noritoshi Hiranuma
    • 1
  • Akihide Konishi
    • 1
  • Hiroto Kinutani
    • 1
  • Masaru Kuroda
    • 1
  • Ken-ichi Hirata
    • 1
  1. 1.Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan

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